STATE OF NEVADA
STATE OF NEVADA
1
DCFS Staff Acknowledgement of Medication and Administration Management Training and Policy
I acknowledge that I have received the required DCFS training about Medication Administration and Management pursuant to DCFS SP-5 Medication and Administration for Residential Programs Policy from my supervisor. I also acknowledge that I have read and understand the DCFS SP-5 Medication and Administration for Residential Programs Policy dated _________________________.
Insert Revision Date of Policy
I understand this signed statement will be placed in my Agency Personnel File as confirmation that I have received this training and that I understand the policy and practice requirements.
____________________________________ ______________________________________
Print Employee’s Name Employee’s Signature
____________________________________
Date
By affixing my signature below, I confirm I am the supervisor of the above noted DCFS employee and that I have trained this DCFS staff member on the current Medication Administration and Management Policy. I further confirm that the DCFS staff member has demonstrated an understanding of this policy.
The training provided was: Initial Training ________________________________(Date)
Annual/Refresher Training _______________________ (Date)
____________________________________ _______________________________________
Supervisor’s Signature Date
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BRIAN SANDOVAL
Governor
Michael J. Willden
Director
Department of Health and Human Services
Amber Howell
Administrator
Division of Child and Family Services
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Department of Health and Human Services
Division of Child and Family Services
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